Provider Demographics
| NPI: | 1467589705 |
|---|---|
| Name: | GREATER BALTIMORE MEDICAL CENTER, INC. |
| Entity Type: | Organization |
| Organization Name: | GREATER BALTIMORE MEDICAL CENTER, INC. |
| Other - Org Name: | GBMC PHYSICIANS |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | EXECUTIVE VICE PRES AND CFO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | ERIC |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | MELCHIOR |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 443-849-2519 |
| Mailing Address - Street 1: | PO BOX 631568 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BALTIMORE |
| Mailing Address - State: | MD |
| Mailing Address - Zip Code: | 21263-1568 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 443-204-8188 |
| Mailing Address - Fax: | 443-204-8246 |
| Practice Address - Street 1: | 6701 N CHARLES ST |
| Practice Address - Street 2: | |
| Practice Address - City: | BALTIMORE |
| Practice Address - State: | MD |
| Practice Address - Zip Code: | 21204-6808 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 443-849-2000 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | GREATER BALTIMORE MEDICAL CENTER, INC. |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2007-02-27 |
| Last Update Date: | 2007-07-23 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | Group - Multi-Specialty |
| No | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | Group - Multi-Specialty |
| No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
| No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2083P0011X | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MD | 709L | Medicare PIN | |
| MD | 713L | Medicare PIN | |
| MD | 714L | Medicare PIN | |
| MD | 717L | Medicare PIN | |
| MD | 710L | Medicare PIN | |
| MD | 716L | Medicare PIN | |
| MD | 711L | Medicare PIN | |
| MD | 703L | Medicare PIN | |
| MD | 720L | Medicare PIN | |
| MD | 700L | Medicare PIN | |
| MD | 704L | Medicare PIN | |
| MD | 712L | Medicare PIN | |
| MD | 725L | Medicare PIN | |
| MD | K254 | Medicare PIN | |
| MD | 676L | Medicare PIN | |
| MD | K303 | Medicare PIN | |
| MD | 701L | Medicare PIN | |
| MD | 705L | Medicare PIN | |
| MD | 719L | Medicare PIN |
